Journal of neurotrauma
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The objective of this study was to use a prospective cohort of United States Marine Corps (USMC) instructors to identify any acute or long-term vestibular dysfunction following repeated blast exposures during explosive breaching training. They were assessed in clinic and on location during training at the USMC Methods of Entry School, Quantico, VA. Subjects received comprehensive baseline vestibular assessments and these were repeated in order to identify longitudinal changes. ⋯ The data trends also suggest that this nystagmus could be an acute blast effect. However, the reasons for the abnormally short phase leads seen in rotary chair testing are unclear at this time. Further investigation seems warranted.
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Journal of neurotrauma · Jan 2016
Differences in Regional Brain Volumes Two Months and One Year after Mild Traumatic Brain Injury.
Conventional structural imaging is often normal after mild traumatic brain injury (mTBI). There is a need for structural neuroimaging biomarkers that facilitate detection of milder injuries, allow recovery trajectory monitoring, and identify those at risk for poor functional outcome and disability. ⋯ These differences persisted but were reduced in magnitude 1 year after injury, suggesting the possibility of normalization over time in the affected regions. More pronounced differences, however, were found in the amygdala and hippocampus, suggesting the possibility of regionally specific responses to injury.
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Journal of neurotrauma · Jan 2016
ReviewBrain Networks Subserving Emotion Regulation and Adaptation after Mild Traumatic Brain Injury.
The majority of patients with traumatic brain injury (TBI) sustain a mild injury (mTBI). One out of 4 patients experiences persistent complaints, despite their often normal neuropsychological test results and the absence of structural brain damage on conventional neuroimaging. Susceptibility to develop persistent complaints is thought to be affected by interindividual differences in adaptation, which can also be influenced by preinjury psychological factors. ⋯ In this article, we aim to integrate findings from functional and structural MRI studies on this topic. Alterations within the default mode, executive and salience network have been found in relation to complaints post-mTBI. Dysfunction of the medial prefrontal cortex may impair network dynamics for emotion regulation and adaptation post-mTBI, resulting in persistent post-concussive complaints.
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Journal of neurotrauma · Jan 2016
Lack of standardization in the use of the Glasgow Coma Scale. Results of international surveys.
The Glasgow Coma Scale (GCS) was introduced 40 years ago and has received world-wide acceptance. The GCS rates eye, motor, and verbal responses to assess the level of consciousness. Concerns have been expressed with regard to reliability and consistency of assessments. ⋯ Moreover, different approaches were used when one of the components could not be assessed. Overall, the surveys have identified a general lack of standardization in assessment and reporting of the GCS. The results illustrate the need for continued education to improve reliability of assessments through guidance to a standard approach.
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Journal of neurotrauma · Jan 2016
Modelling of community integration trajectories in the first 5 years after traumatic brain injury.
The aims of this study were to assess the trajectories of community integration in individuals with traumatic brain injury (TBI) through one, two, and five years post-injury and to examine whether those trajectories could be predicted by demographic and injury characteristics. A longitudinal cohort study was conducted with 105 individuals with moderate-to-severe TBI admitted to a trauma referral center in 2005-2007. Demographics and injury-related factors were extracted from medical records. ⋯ Additionally, higher trajectories of community integration were predicted by being single at the time of injury (p<.001), higher level of education (p=0.006), employment (p<0.001), and a shorter length of PTA (p<0.001). In a follow-up HLM with interaction terms, time*PTA was statistically significant (p<0.001), suggesting that participants with longer PTA increased in community integration more rapidly than those with shorter PTA. The longitudinal course of community integration described in this study may help rehabilitation professionals to plan more extensive follow-ups and targeted rehabilitation programs in the early stage of recovery for patients with specific demographic and injury characteristics.